I screen, you screen, we all scream for risk screens

Abstract

Ever since the 1998 publication of the groundbreaking Adverse Childhood Events study by Felitti et al (Am J Prev Med 1998;14:245-58), researchers and clinicians have been working to expand the science and develop tools that screen for factors associated with the development of toxic stress. The science is well established that adverse childhood experiences (ACEs) can lead to disrupted neurodevelopment. If not buffered or mitigated, impairment in the social, emotional, and cognitive domains follow leading to high risk behaviors and their sequelae. Poverty and the frequently associated unmet social needs constitute risk factors for toxic stress and ACEs. But zip codes or ACEs do not have to represent biologic destiny. A large number of social determinants of health (SDOH) screens have been rigorously studied in research settings. These include the IHELLP (Pediatrics 2007;120:e734-8) and WE CARE (Pediatrics 2007;120:547-58) tools. One of best-known models for screening for ACEs comes from the work of Nadine Burke Harris at the Center for Youth Wellness. Any of these patient screening tools require a knowledge of and access to community and mental health resources as well as refinement based on local need. What is a busy pediatrician supposed to do? In this volume of The Journal, Selvaraj et al present their findings from a real-world application of a toxic stress risk factor (ACEs and SDOH) screen. Although less effective at screening for ACEs, the screen was feasible and acceptable to families in busy urban academic practices. Inevitably, the USPSTF will weigh the strength of evidence for these screens. Until then, we will rely on increasingly creative approaches. Article page 244 ▶ Screening for Toxic Stress Risk Factors at Well-Child Visits: The Addressing Social Key Questions for Health StudyThe Journal of PediatricsVol. 205PreviewTo determine the prevalence of and demographic characteristics associated with toxic stress risk factors by universal screening, the impact of screening on referral rates to community resources, and the feasibility and acceptability of screening in a medical home setting. Full-Text PDF